A mental health nurse is caring for a newly admitted client with obsessive-compulsive disorder (OCD). Which of the following actions should the nurse take first?

Choice A rationale:

Suppression involves the conscious, intentional effort to push unwanted thoughts, feelings, or memories out of awareness. It is not evident in the client's statement, as they are not actively trying to forget or avoid their alcohol use. Instead, they are attempting to justify it.

Choice B Rationale:

Rationalization is the defense mechanism most clearly demonstrated in the client's statement. It involves creating false but seemingly logical reasons to justify unacceptable behavior or feelings. The client is attributing their alcohol use to external factors (their boss and job requirements) rather than taking responsibility for their own choices and actions. This allows them to avoid confronting the reality of their addiction and the need for change.

Key characteristics of rationalization that align with the client's statement:

Externalizing blame: The client places responsibility for their drinking on their boss and job, rather than acknowledging their own agency.

Minimizing the problem: The client suggests that their drinking was merely a necessary part of their job, downplaying the extent of their alcohol use and its negative consequences.

Avoiding negative emotions: By shifting blame, the client protects themselves from feelings of guilt, shame, and responsibility associated with their addiction.

Choice C Rationale:

Reaction formation involves behaving in a way that is opposite to one's true feelings or impulses. This is not evident in the client's statement, as they are not expressing overly negative or critical attitudes towards alcohol. Instead, they are attempting to justify their use of it.

Choice D Rationale:

Compensation involves overemphasizing a desirable trait or behavior to make up for a perceived weakness or deficiency. This is not evident in the client's statement, as they are not highlighting any positive qualities or accomplishments to offset their alcohol use.

Choice A rationale:

Altered body image is a hallmark feature of eating disorders. Individuals with eating disorders often have a distorted perception of their bodies, believing they are overweight or larger than they actually are. This distorted body image can lead to intense dissatisfaction with their appearance, even when they are underweight. They may engage in obsessive behaviors such as repeatedly checking their weight, measuring their body parts, and avoiding mirrors. They may also fixate on perceived flaws in their appearance, leading to significant distress and impairment in their daily lives.

Choice B rationale:

Amenorrhea, the absence of menstruation, is a common physiological consequence of eating disorders. It occurs due to hormonal imbalances caused by insufficient intake of calories and nutrients, particularly fat. The body requires a certain amount of body fat to maintain normal reproductive function. When body fat levels fall below a critical threshold, the hypothalamus, a part of the brain that regulates hormone production, signals the pituitary gland to reduce the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones play crucial roles in ovulation and menstruation. Without adequate levels of FSH and LH, ovulation and menstruation do not occur.

Choice C rationale:

Hyperactivity, characterized by excessive energy and restlessness, can manifest in individuals with eating disorders. This increased activity level may be a way to burn calories or compensate for perceived overeating. It may also be a way to distract themselves from thoughts about food and body image. The hyperactivity can present in various forms, such as excessive exercise, fidgeting, or constant movement.

Choice D rationale:

Bradycardia, a slower-than-normal heart rate, is another physiological sign that can accompany eating disorders. It occurs as the body attempts to conserve energy in response to inadequate caloric intake. The heart rate slows down to minimize energy expenditure. Bradycardia can have serious health implications, including fatigue, dizziness, fainting spells, and potentially life- threatening heart arrhythmias.

Choice E rationale:

Verbalized desire to gain weight is not a typical manifestation of eating disorders. Individuals with eating disorders often have a strong fear of weight gain and a persistent drive for thinness. They may actively resist efforts to increase their weight, even when they are dangerously underweight.